PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention?

Population-based interventions have the potential to improve patient care and population health outcomes. However, some interventions may not be considered to be in every individual’s best interest in every situation, resulting in ethical and legal issues for public health professionals. Furthermore, population-based interventions can push public health nurses (PHNs) toward traditional public health ethics, where decisions are based on the primary concern for large groups of individuals (DeCamp et al., 2018). PHNs are required to uphold the ethical principles of beneficence and nonmaleficence when planning and implementing population-based interventions. Beneficence requires PHNs to support interventions that benefit individuals, while nonmaleficence requires PHNs to ensure the interventions cause no harm (DeCamp et al., 2018). Nonetheless, the lines between harmful, non-beneficial, and beneficial effects of population health interventions for individuals may blur.

Interventions could enhance a population’s overall health while causing unintended non-beneficial, or even harmful, consequences to individuals, which can result in legal consequences. Legal aspects of implementing a population-based intervention align with justice. PHNs are expected to uphold procedural justice by ensuring that fair decision processes govern individual and organizational deliberations. It requires opportunities to involve individuals in their care and healthcare decision-making (Shahzad et al., 2019). PHNs are also required to observe regulations when implementing population-based interventions. For example, the law regulates public health officials by requiring the development of safer interventions. Thus, the PHNs must observe the regulations and implement safe interventions for the target population.

The smoking ban in public places is an example of a population-based intervention. It accounts for ethical standards by promoting the overall health of the general population by reducing exposure to second-hand smoke. This prevents harm to individuals by reducing their risk of passive smoking-related diseases, thus upholding nonmaleficence (Shahzad et al., 2019). It also accounts for legal standards by outlining that there should be specific locations for smoking, allowing smokers to smoke. Regulation standards are accounted for by adhering to the environmental regulations on reducing smoke emissions.

References

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., Reynolds, P. P., Sulmasy, L. S., & Tilburt, J. (2018). Ethical Issues in the Design and Implementation of Population Health Programs. Journal of general internal medicine, 33(3), 370–375. https://doi.org/10.1007/s11606-017-4234-4

Shahzad, M., Upshur, R., Donnelly, P., Bharmal, A., Wei, X., Feng, P., & Brown, A. D. (2019). A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration. BMC Public Health, 19(1), 1-15. https://doi.org/10.1186/s12889-019-7002-z

Public health professionals consider nursing ethics, and legal and regulatory laws during the development and interpretation of population-based interventions. The rationale is that despite population-based interventions benefiting most patients, in some circumstances they may not benefit every individual (DeCamp et al., 2018). Ethics and regulations protect populations from harm and guide nurses to implement evidence-based interventions with high benefits and low human risks. Ethical aspects of implementing a population-based intervention include non-maleficence, beneficence, respect for persons, and justice (DeCamp et al., 2018). Ethics of non-maleficence and beneficence guide nurses not to harm patients and to act in the patient’s best interest.

PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention

Caregivers should respect patients’ choice to either participate or not participate in population-based interventions by supporting free and informed decisions. In addition, nurses should observe patient justice through a fair decision process and allocation of health improvement resources (DeCamp et al., 2018). Nurses are committed primarily to the best interests of individual patients, thus observe these ethics to maintain trust in the medical profession. According to Lévesque et al. (2018), adequate management of ethical, legal, and regulatory aspects related to population-based interventions’ implementation promotes optimal translation of scientific evidence into clinical practice. Therefore, healthcare organizations should design evidence-based population interventions that align with nursing ethics, nurse responsibilities, and patient preference and needs.

One existing population-based intervention is the Omics-based risk prediction of women’s cancer. The intervention accounts for the ethics of autonomy and informed consent by ensuring caregivers provide relevant screening information, the significance of the interventions, and the implications of the genetic test to promote informed decision-making (Lévesque et al., 2018). Public health nurses also consider social inequities and potential barriers to the equitable access of the developed intervention due to discrimination by insurers. Public health professionals enforce anti-discrimination legislation and restrict access to cancer prediction results to protect patients.

References

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., … & Tilburt, J. (2018). Ethical issues in the design and implementation of population health programs. Journal of general internal medicine, 33(3), 370- 375. doi: 10.1007/s11606-017-4234-4.

Lévesque, E., Kirby, E., Bolt, I., Knoppers, B. M., de Beaufort, I., Pashayan, N., & Widschwendter, M. (2018). Ethical, legal, and regulatory issues for the implementation of omics-based risk prediction of women’s cancer: Points to consider. Public Health Genomics, 21(1-2), 37-44. doi: 10.1159/000492663.

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Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient’s best interest in every circumstance, which can create ethical stress for individual physicians and other healthcare professionals. Primely, because individual health care professionals remain committed mainly to the best interests of the patients. All healthcare providers have a unique role to play in providing population health supports this ethical obligation(Lévesque, et. al.,2018)With that there are some ethical, legal, and regulatory aspects to consider when implementing a population -based intervention are respect, beneficence and justice. These are the principles that form the foundation of ethics research today. It’s important to implement all these principles in all health care channels from the informed consent process to privacy and confidentiality.

One example suggested by DeCamp, et al., pg,33(3), 370–375,2018 “In practice, the lines between harmful, non-beneficial, and beneficial effects of PHPs for individual patients may blur. PHPs could improve a population’s overall health while resulting in unintended non-beneficial or even harmful individual consequences. For instance, implementing a standard colorectal cancer screening metric with an age cut off of 75 year ; as might be done with an electronic health record pop-up reminder; appears to have been associated with under screening of healthy individuals over age 75 and over screening of unhealthy individuals under age Unintentionally, a metric appeared to discourage appropriately individualized clinical decision-making.” This was one great example and as future advance practice nurses it important to practice these standards in the health care setting.

References

Lévesque, E., Kirby, E., Bolt, I., Knoppers, B. M., de Beaufort, I., Pashayan, N., & Widschwendter, M. (2018). Ethical, Legal, and Regulatory Issues for the Implementation of Omics-Based Risk Prediction of Women’s Cancer: Points to Consider. Public health genomics, 21(1-2), 37–44. https://doi.org/10.1159/000492663

Population-based interventions goals of improving population health, reducing health care cost, and improving population health, reducing health care cost, and improving patient experience with care can be achieved through the implementation of population health interventions/programs in health organizations and community settings. While implementing population-based intervention programs are known to benefit both individual and the community, advocates for the programs acknowledge that some intervention programs may not be in the best interest of every individual or population in all circumstances (DeCamp et al., 2018). Thus, the need to address the ethical, legal, and regulatory aspects when implementing population-based interventions or programs.

Public health ethics seeks to understand and clarify principles and values which guide public health actions (CDC, 2017). Thus, making sure that the population-based interventions being implemented is respectful, is fairly distributing resources, is culturally sensitive, is benefiting the population who needs it, and is improving the care that is delivered to patients will address a few ethical concerns that can arise (DeCamp et al., 2018).

One existing population-base intervention is the Covid-19 vaccination policy. This community health intervention accounts for ethical, legal and regulatory standards by local and federal government agencies implementing programs that provide for qualify members in every community to be vaccinated against the Covid-19 virus. The implementation of this intervention provides resources for all members, within the community to be tested for the virus free of charge, and with the chance of being vaccinated if he/she chooses to do so. This addresses the ethical issues of justice for all. To prevent the spread of virus, laws and regulations such as wearing of the mask, and quarantining when positive with the virus were implemented to help in protecting the health of the public/community (CDC, 2022).

References

Center for Disease Control and Prevention. (2018). Public Health Ethics

https://www.cdc.gov/os/integrity/phethics/index.htm

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., Reynolds, P P., Sulmasy, L.S., & Tilburt, J. (2018).

Ethical Issues in the Design and Implementation of Population Health Programs. Journal of general internal medicine, 33(3), 370-375. https://doi.org/10.1007/s11606-017-4234-4

Ethical, legal and regulatory aspects help to guide population-based interventions. There are 4 ethical principles: non- maleficence autonomy, justice, and beneficence Policies are guided by the review of the legal powers and responsibilities of a country to make sure that people are healthy and to ensure that the country has the ability to limit autonomy, freedom, privacy, and other legal interests of individuals for common good. These strategies must follow the ethical standards which require evidence-based public health rules based on comprehensive high-quality information on both legal actions and the optimal targets for health and well-being. The main and classical purpose of public health is to avoid diseases rather than treat diseases (Saleh et al., 2021).

An example of an existing intervention is breast feeding. When a baby is left to a mother and family to be breastfed and supplemented on pure instinct it would likely be safer than a child experiencing Baby-Friendly protocol. When a feeding policy’s primary goal is exclusive breastfeeding at discharge while the vast majority of mothers cannot produce the calories and fluid required to keep their babies from fasting, the hospital policy is causing harm. When that feeding policy tolerates a child crying for milk for hours to days as they breastfeed non-stop for survival, the hospital policy is causing harm (MD, C.D, 2018). The non-maleficence principle requires professionals to do no intentional harm or injury to a patient through acts of commission or omission.

References

MD, C. D. (2018, September 24). Breastfeeding Before Babies: The BFHI’s Unwillingness to Change. Retrieved from https://fedisbest.org/2017/03/breastfeeding-babies-baby-friendly-hospital-initiatives-unwillingness-change-accept-responsibility/

Saleh, B. M., Aly, E. M., Hafiz, M., Abdel Gawad, R. M., El Kheir-Mataria, W. A., & Salama, M. (0001, January 01). Ethical Dimensions of Public Health Actions and Policies With Special Focus on COVID-19. Retrieved from https://www.frontiersin.org/articles/10.3389/fpubh.2021.649918/full

The primary goal of ethical, legal, and regulatory are to prevent harm and protect each patient for any health intervention. Ethical principles and theories are developed to guide public health professionals including public health nurses in making ethical decisions (Stanhope & Lancaster, 2019). Some examples of these ethical principles are respect for autonomy, non-maleficence, beneficence, and distributive justice. Law and regulations are strategies used by government to try to prevent injury and disease and promote the population’s health. It can intervene at a variety of levels which are designed to promote safe behavior among the population to include individual behavior, agents of behavior change, and the environment (Haddon et al., 1964; Institute of Medicine, 1999 as cited in Smedley & Sym, 2000). Government intervention focus first on individual behavior which is express through education, incentives, and deterrence. An example would be taxing unhealthy vices like cigarettes to discourage risk behaviors. The second law imposed the agents of behavior change by requiring safer products such as government regulating safety features of car seat. The third law alters informational, physical, social, or economic environment to promote safer behavior (Smedley & Sym, 2000).

An example of existing intervention is the recent change of smoking age limit from 18 years old to 21 years old or also know as Tobacco 21. This law prevents retailer from selling smoke products to individuals age below 21 years old (U.S. Food and Drug Administration, 2021). The ethical principle that accounts for this intervention is “Beneficence” which emphasized to do no harm (Stanhope & Lancaster, 2019). This law promotes the health of the youth and prevent them for being at risk for smoking related illnesses.

Reference

Smedley, B.D. & Sym, S.L. (2000). Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington (DC): National Academies Press (US). Legal and Public Policy Interventions to Advance the Population’s Health. https://www.ncbi.nlm.nih.gov/books/NBK222835/

Stanhope, M. & Lancaster, J. (2019). Public health nursing: Population-centered health care in the community (10th ed.). St. Louis, MO: Elsevier. ISBN-13: 9780323582247

U.S. Food and Drug Administration. (2021). Tobacco 21. Retrieved from https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21

When implementing population-based intervention it is important to factor in ethical, legal, and regulatory aspects of community intervention. Ethical behavior in community interventions relates to the treatment of people, information, and money, and the general actions of the workers and the organization or initiative, even when they’re not dealing directly with the community. Ethical behavior for a community intervention is more than simply following professional codes and keeping your nose clean. It means actively striving to do what is right for participants and the community and treating everyone ethically. Nurses can advocate for access to consistent, effective, efficient healthcare for all in our society, (Stanhope & Lancaster, 2018). Nurses need to be knowledgeable about legal and regulations in the policies since they participate in carrying out family policy and are responsible for informing the state regarding the services they provide. Nurses participate in enforcing laws and regulations that affect the family such as state immunization laws. To ensure that the population-based intervention is promoting shared decision-making in patient-centered care settings work well, it is important to identify all associated ethical, legal, and regulatory considerations.

An example of existing intervention is patient-centered care in the Patient Protection and Affordable Care Act which aims to improve the aspects of healthcare delivery and health outcomes (Smith, 2016 as cited in StudyCorgi, 2021). This type of care promotes improved self-management, patient satisfaction, and adherence to medication. Ethical, legal, and regulatory standards within healthcare are important because workers must recognize healthcare dilemmas, and make good judgments and decisions based on their values while keeping within the laws that govern them. Professional codes of ethics generally cover everything from the use of accepted methods to professional development to billing practices. People in a particular field are expected to be familiar with their professional code of ethics, law, and regulatory standards and to adhere to it under all circumstances. when implementing serves, (Community Tool Box, 2018).

References

Community Toolbox, (2018). Ethical issues in community interventions, Chapter 19, section 5. Retrieved from: https://ctb.ku.edu/en/table-of-contents/analyze/choose-and-adapt-community-interventions/ethical-issues/main

Stanhope, M. & Lancaster, J. (2019). Public health nursing: Population-centered health care in the community (10th ed.).

StudyCorgi. (2021). Ethical, Legal, and Regulatory Considerations in Health Care: Shared Decision-Making. Retrieved from https://studycorgi.com/ethical-legal-and-regulatory-considerations-in-health-care-shared-decision-making/

PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention?